Effect of sex on sodium‐glucose co‐transporter‐2 antagonists and glucagon‐like peptide‐1 agonists in heart failure

Abstract

Abstract Background Recent evidence suggests that medications not primarily targeting the cardiovascular (CV) system may have cardioprotective effects in patients with heart failure (HF), in particular the anti‐diabetic therapies sodium‐glucose co‐transporter‐2 (SGLT‐2) antagonists and glucagon‐like peptide‐1 (GLP‐1) agonists. We conducted a systematic review to assess the pooled evidence for the use of SGLT‐2 antagonists and GLP‐1 agonists in patients with HF and the effect of biological sex on the results. Methods MEDLINE, Embase, Cochrane Library and clinical trial databases were searched until February 2023. Randomized controlled trials (RCTs) published in English that included adult participants with HF who were randomized to an SGLT‐2 antagonist or GLP‐1 agonist with a primary or secondary outcome of HF hospitalization (HFH) or CV death were eligible for inclusion. Data pooling was undertaken using a random effects model and odds ratios (ORs) to determine the association between drug and outcome. Sub‐group analyses to investigate sex differences were conducted. Results Six RCTs were included (24 781 patients). Four studies investigated SGLT‐2 antagonists, and two studies examined GLP‐1 agonists. SGLT‐2 antagonists improved HFH {OR [95% confidence interval (CI)]: 0.69 [0.63, 0.77], P 0.05). Conclusions SGLT‐2 antagonists but not GLP‐1 agonists beneficially affect HFH and CV death in patients with HF with or without diabetes. We show for the first time that GLP‐1 agonists have a neutral effect on HFH and CV death in both male and female HF patients and a reduction in HFH and CV death in male and female HF patients taking SGLT‐2 antagonists.

Keywords

• cardiovascular death
• GLP‐1 agonist
• heart failure
• hospitalization
• sex
• SGLT‐2 antagonist